In the early 1980s, the first AIDS cases began to appear in the United States. Researchers worked against the clock to find answers to critical life-or-death questions: Who was most at risk? What factors made them so vulnerable? Because HIV struck first among men, the risk factors for other populations were largely overlooked.

In 1987, however, the HIV Center for Clinical and Behavioral Studies, a joint initiative of Columbia University and the New York State Psychiatric Institute, was founded and quickly became a recognized veteran leader in the fight against AIDS among different populations. Its researchers conduct interdisciplinary research on HIV/AIDS-related issues including behavior change, sexuality, mental health and ethics and policy. A core part of its work focuses on offering outreach and support to a broad range of HIV-infected and -affected populations in New York City, particularly women, children and families.

This year, as it marks its 20th anniversary, the center's founders marvel that they are still working on what has become a global challenge. "I never thought the center would be around 20 years later," said Anke Ehrhardt, who co-founded the HIV Center with another Columbia professor, Zena Stein, who is now co-director emerita. "We thought the center would exist for maybe five to 10 years max. We never thought that AIDS would become the global epidemic it is today. In response, the center grew, and we stayed."

Ehrhardt, a sexuality and gender researcher from Germany, was an associate professor of psychology in the department of psychiatry at Columbia at the start of the epidemic, but found herself among a group of researchers working to understand the complexities of the disease as it emerged. Responding in 1987 to a call from the National Institute of Mental Health for an interdisciplinary research center on HIV/AIDS, the group received a $19 million grant from the institute to establish the HIV Center.

The center was the first to conduct major studies documenting the risk of HIV infection among the seriously mentally ill and advance early prevention efforts for this population. It also identified the hardships facing families with HIV-positive parents or children, and established some of the first programs to support their needs.

"There are a number of lines of research where we have made significant contributions, one area is women, where we took an early role," said Ehrhardt. "We really sounded the alarm on behalf of women, working to get their agenda defined, particularly in regard to how much control women have in protecting themselves. This has become a hallmark of our work."

A 1987 meeting at the HIV Center for Clinical and Behavioral Studies

Image credit: HIV Center forClinical and Behavioral Studies

In the U.S., the transmission of HIV from pregnant women to their children has been vastly reduced, and people with HIV are living much longer, thanks to improved access to better treatment. However, in other parts of the world, the biggest challenge is getting medication to AIDS patients, and stigma and discrimination are still major obstacles to fighting the epidemic.

"We cannot treat ourselves out of this epidemic," said Ehrhardt. "We still must work to raise awareness about protection, gender equity and to fight stigma and discrimination. At the beginning of the epidemic, no one was aware of its enormity. It's incredible that today, countries have to go through the same script as we did in those early days—denial, stigma, gender inequality and silence."

With two decades of experience and lessons learned, the center is now looking to its future. Earlier this year it received a five-year $10 million renewal from the National Institute of Mental Health to continue its work. The renewal included the establishment of the Global Community Core, which brings together a diverse international group of experts from academia, government and community-based organizations to advance research on the global epidemic and its impact on more than 40 million HIV-positive people. The center today is active in eight countries—South Africa, Brazil, Nigeria, China, Vietnam, Egypt, Argentina and the Dominican Republic.

As for the future of the epidemic, Ehrhardt sees a greater push and a much-needed return to issues closer to home. "There will be heightened need for greater prevention work in New York City," she said. "We need leaders who are trained to fight the epidemic: community, scientific, government and health. We need inspired and creative leadership."